Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials.

BACKGROUND: Randomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups. METHODS: A systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy. RESULTS: Data from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3-1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02-1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference -6.97 days). Outcomes remained stable in the high-risk subgroups. CONCLUSION: LPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.

A comparative prospective study of short-term outcomes of extended view totally extraperitoneal (e-TEP) repair versus laparoscopic intraperitoneal on lay mesh (IPOM) plus repair for ventral hernia.

BACKGROUND: Currently, minimally invasive approach is preferred for the treatment of ventral hernias. After the introduction of extended view totally extraperitoneal (e-TEP) technique, there has been a constant debate over the choice of better approach. In this study, we compare the short-term outcomes of e-TEP and laparoscopic IPOM Plus repair for ventral hernias. METHODS: This is a comparative, prospective single-center study done at GEM Hospital and research center Coimbatore, India from July 2018 to July 2019. All patients who underwent elective ventral hernia surgery with defect size of 2 to 6 cm were included. Patient demographics, hernia characteristics, operative and perioperative findings, and postoperative complications were systematically recorded and analyzed. RESULTS: We evaluated 92 cases (n = 92), 46 in each group. Mean age, sex, BMI, location of hernia, primary and incisional hernia, and comorbidity were comparable in both the groups. Mean defect size for IPOM Plus and e-TEP was 4 cm and 3.89 cm, respectively. Operative time was significantly higher for e-TEP, while postoperative pain (VAS), analgesic requirement, and postoperative hospital stay were significantly less as compared to IPOM Plus. However, 2 cases (4.35%) of e-TEP had recurrence but none in IPOM Plus group. CONCLUSION: e-TEP is an evolving procedure and comparable to IPOM Plus in terms of postoperative pain, analgesic requirement, cost of mesh, and length of hospital stay. More randomized controlled and multicentric studies are required with longer follow-up to validate our findings.

Modified laparoscopic keyhole plus repair to manage a parastomal hernia: A single-center experience.

INTRODUCTION: Parastomal hernia (PH) is a common late complication of stoma formation for which laparoscopic repair is a well-accepted modality of treatment. Keyhole repair has been frequently reported with recurrence, but our modification in surgical technique have lesser and acceptable recurrence rates. The present study aimed to assess the results of modified laparoscopic keyhole plus repair in the treatment of symptomatic PH. METHODS: We reviewed our prospectively maintained database to search for patients who had undergone laparoscopic modified keyhole repair between January 2008 and April 2018. All 23 symptomatic patients who had undergone this procedure were included in the present study. RESULTS: A total of 23 patients were studied. The median age was 37 years (range, 22-54 years). Two patients with large PHs underwent open excision of the redundant skin and then laparoscopic modified keyhole repair. There was one conversion to open repair because of dense adhesions. The mean operative time was 112 ± 37 minutes. The mean postoperative hospital stay was 3 ± 2 days. There were no significant intraoperative or postoperative complications. During follow-up, three patients had a seroma, which was managed conservatively. One morbidly obese patient who had an ileal conduit-related stomal hernia had a symptomatic recurrence 3 years after surgery. CONCLUSION: The modified laparoscopic keyhole plus repair is a safe, feasible, and effective technique for PH repair; it has an acceptable recurrence rate and offers good cosmesis and functional outcomes.

Laparoscopic Roux-en Y duodenojejunostomy: A safe and physiological treatment for symptomatic annular pancreas in adults.

Background: Annular pancreas is a rare, congenital, rotational anomaly of pancreas, seen usually in newborns who present with features of duodenal obstruction. However, in adults, only 24% of cases are present with duodenal obstruction. Surgery remains the procedure of choice in patients in whom symptoms can be attributed to duodenal obstruction and the goal of surgery is to relieve obstruction by bypassing the annulus. Laparoscopic Roux-en Y duodenostomy (DJ) is our preferred bypass approach for this condition. Literature search revealed that very few case reports have been published about laparoscopic management of annular pancreas, especially about duodenojejunal anastomosis. We present our experience in the laparoscopic management of symptomatic annular pancreas in adults and technique of the laparoscopic Roux-en Y DJ for annular pancreas. Materials and Methods: Between 1996 and 2016, a total of six adult patients underwent laparoscopic management for symptomatic annular pancreas. The demographic, perioperative and follow-up details were documented. Results: All surgeries were successfully performed by laparoscopic approach with no conversion to open. Five cases underwent Roux-en Y DJ and one underwent gastrojejunostomy. No major perioperative events occurred. The mean length of hospital stay was 5.6 days. Five out of six patients were followed up for 24 months, and no symptom recurrence was seen. Conclusion: Laparoscopic Roux-en Y duodenojejunostomy could be used as a safe and physiological treatment for annular pancreas in adult patients and should be preferred for the treatment of duodenal obstruction due to annular pancreas.

Surgery for cystic tumors of pancreas: Report of high-volume, multicenter Indian experience over a decade.

BACKGROUND: Pancreatic cystic neoplasms remain uncommon. Although data are accumulating on the incidence of pancreatic cystic neoplasms in the published literature, Indian data on these tumors are sparse. MATERIAL AND METHODS: We collated data from prospectively maintained databases of patients operated for cystic tumors of the pancreas from 2007 to 2016 at 7 academic centers across India to gain insights into clinical presentation and outcome of the operative treatment of these tumors. Data were compared with large series across the world to understand the regional differences in this pathology. RESULTS: Of the 423 patients, there were 98 (23.2%) serous cystic neoplasms, 128 (30.2%) mucinous neoplasms, 34(8%) intraductal papillary mucinous neoplasms, and 121 (28.6%) solid pseudopapillary epithelial neoplasms managed in these 7 academic centers. Malignancy (adenocarcinoma, malignant intraductal papillary mucinous neoplasms, and mucinous cystadenocarcinoma) was reported in 39 (9.2%) patients. Median age at presentation was 41 years, and the female-to-male ratio was 3.4:1. At presentation, 81% of patients were symptomatic. A total of 66.7% of lesions were located in body and tail region of the pancreas. Median tumor size was 6 cm. Operative resection with curative intent was performed in 405 of these 423 patients. Major morbidity occurred in 12%, and 30-day perioperative mortality was 0.9%. Laparoscopic resections were performed in 18% and spleen-preserving resections were performed in 3% of patients. CONCLUSION: Female preponderance, young age, and a benign nature of most pancreatic cystic neoplasms were observed. Large size of tumors on presentation, fewer intraductal papillary mucinous neoplasm resections, and a much greater incidence of solid pseudopapillary epithelial neoplasms were distinctive of this study. Although the proportion of laparoscopic resections and splenic preservation was less compared with Western centers, the perioperative morbidity and mortality was on par with established standards.

Robotic-assisted minimally invasive oesophagectomy for cancer: An initial experience.

BACKGROUND: The morbidity related to radical oesophagectomy can be reduced by adopting minimally invasive techniques. Over 250 thoraco-laparoscopic oesophagectomy (TLE) was done in our centre over the last 15 years, before adopting robotic surgery as the latest innovation in the field of minimally invasive surgery. Here, we share our initial experience of robotic-assisted minimally invasive oesophagectomy (RAMIE) for carcinoma oesophagus. METHODS: A prospective observational study conducted from February to December 2017. A total of 15 patients underwent RAMIE in this period. Data regarding demography, clinical characteristics, investigations, operating techniques, and post-operative outcome were collected in detail. RESULTS: There were 10 (66.7%) male patients and the median age of all patients was 62.9 (range 36-78) years. The median body mass index was 24.4 (range 15-32.8) kg/m2. Twelve (80.0%) patients had squamous cell carcinoma (SCC) of the oesophagus and 3 (20%) patients had adenocarcinoma (AC). Five (33.3%) patients received neoadjuvant therapy. All 15 patients underwent RAMIE. Patients with SCC underwent McKeown's procedure, and those with AC underwent Ivor Lewis procedure. Extended two-field lymphadenectomy (including total mediastinal lymphadenectomy) was done for all the patients. The median operating time was 558 (range 390-690) min and median blood loss was 145 (range 90-230) ml. There were no intra-operative adverse events, and none of them required conversion to open or total thoracolaparoscopic procedure. The most common post-operative complications were recurrent laryngeal nerve paresis (3 patients, 20.0%) and pneumonia (2 patients, 13.3%). The median hospital stay was 9 (range 7-33) days. In total, 9 (60%) patients required adjuvant treatment. CONCLUSION: Adequate experience in TLE can help minimally invasive surgeons in easy adoption of RAMIE with satisfactory outcome.

Laparoscopic donor hepatectomy: First experience from Indian sub-continent.

Liver transplantation is a ray of hope for thousands of patients with end-stage liver disease but is currently challenged by the scarcity of donor organs worldwide. Unlike kidney transplantation where minimally invasive donor organ procurement has almost become a norm, laparoscopic procurement of hemi-liver from a living donor is still in the infancy of development, at least in the Indian sub-continent. Minimally invasive surgery has made its way into different procedures of hepatobiliary and pancreatic surgery, but only a few centres in the world are performing pure laparoscopic donor hepatectomy. We report two cases of total laparoscopic donor hepatectomy, and to the best of our knowledge, this is the first report from Indian sub-continent.

Laparoscopic management of an unusual case of small bowel obstruction: appendiculoileal knotting.

Appendicitis presenting at small bowel obstruction due to the formation of encircling loop around a bowel segment is a rare occurrence. We report such case managed with the laparoscopic approach. A 45-year-old woman presented to emergency services with severe pain in abdomen and bilious vomiting in the past 2 days, having a history of abdominal hysterectomy 10 years ago. The abdominal examination was suggestive of bowel obstruction. A CT showed dilated bowel loops with complete cut-off at the level of the terminal ileum. The patient was taken for diagnostic laparoscopy. The inspection of the small bowel revealed an appendicular looping around the small bowel lumen. After separating, the appendix obstruction was relieved. Then, the tip of the appendix was dissected free from the parietal wall along with approximately 5 mL purulent fluid. Appendectomy was completed and based looped doubly using catgut endoloop. The patient had an uneventful recovery and was discharged on the second postoperative day.

First robotic pylorus preserving pancreaticoduodenectomy for Frantz's tumour in an adolescent girl.

Solid pseudopapillary tumour (SPT) is one of the uncommon benign cystic neoplasms of pancreas occurring predominantly in young females. Being benign in nature, surgical resection is the treatment of choice with excellent 5-year survival. A 14-year-old girl presented with pain abdomen for 1 week. On evaluation, she was found to have a large SPT involving head and uncinate process of Pancreas She underwent robotic pylorus preserving pancreaticoduodenectomy (R-PPPD) with da Vinci® Si Robotic System (Intuitive Surgical, Sunnyvale, CA, USA). The total operating time was 480 min. Her postoperative recovery was uneventful and she was discharged on postoperative day 6. In the era of minimally invasive surgery, robotic pancreatic resection and reconstruction are becoming more acceptable. Although the operating domain is small in younger age group, the precise movement of robotic arm and high quality magnified three-dimensional view allows the surgeons to perform PPPD on younger patients also. Young female patients suffering from SPTs can electively undergo R-PPPD with minimal morbidity and mortality. R-PPPD can become the treatment of choice for SPTs involving pancreatic head region even in paediatric and adolescent age group.

Laparoscopic choledochoduodenostomy as a reliable rescue procedure for complicated bile duct stones.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction is generally accepted as first line management for common bile duct (CBD) stones. CBD exploration, either by open or laparoscopic approach nowadays, is usually reserved for ERCP failures, complicated stone locations, along with altered anatomical situations. The aim of this study was to highlight the increasing role of laparoscopic choledochoduodenostomy which is not only a reliable but also as a rescue procedure for those failed ERCP cases due to complicated bile duct stones. MATERIALS AND METHODS: It is a retrospective review of the database, from a tertiary care teaching institution from India, from Jan 2012 up to December 2016. RESULTS: Out of total 30 patients who underwent laparoscopic choledochoduodenostomy, 28 had failed ERC stone clearance while two patients were directly offered drainage in view of unfavorable anatomy. The major reasons for failed ERC stone clearance were as follows-multiple large calculi (42.8%), recurrent stones (21.4%), and associated stricture (21.4%). Mean operating time was 130 (± 27) minutes with mean blood loss of 60 (± 19) ml. Stone extraction was successful, primarily by milking in 13 (43.33%) patients, rest required augmentation by Dormia basket/balloon. Two patients (6.66%) developed controlled bile leak which resolved with conservative treatment. The median length of hospital stay was 5 days (IQR 3-9). Mean duration of follow-up was 17 (± 3.2) months. CONCLUSION: Laparoscopic common bile duct exploration with choledochoduodenostomy has been shown to be a safe, reliable, and efficient method for treating complex CBDS, especially after failed ERCP procedures.

Single incision multiport versus conventional laparoscopic inguinal hernia repair: A matched comparison.

BACKGROUND: The popularity of single-incision procedures is on the rise as wound cosmesis is increasingly being seen as an important body image-related outcome. In this study, we assess the potential benefits of single-incision multiport laparoscopic totally extra-peritoneal (S-TEP) without using specialised ports or instruments and compare the same with the conventional laparoscopic TEP (C-TEP) surgery in terms of operative time, post-operative pain, complications, cost and cosmesis. MATERIALS AND METHODS: This is a prospective case-matched study of the patients undergoing S-TEP versus C-TEP from June 2014 to December 2015. RESULTS: Each group had 36 patients. The two groups were comparable in the clinical characteristics. The mean duration of surgery for a unilateral hernia in C-TEP and S-TEP was 45.13 ± 10.58 min and 72.63 ± 15.23 min, respectively. The mean visual analogue scale (VAS) score for pain was significantly higher in S-TEP group at post-operative day (POD) 0 and 1. However, at POD 7, there was no significant difference between the groups. At 1st and 6-week post-surgery, the cosmetic results were significantly better in S-TEP group as compared to C-TEP, however, at 6 months, the scar was highly acceptable in both treatment groups. CONCLUSION: S-TEP, using conventional laparoscopic instruments, is safe and feasible even in resource challenged setting. However, there is a need to review the indications and advantages of single-incision laparoscopic surgery, as no difference in cosmetic outcome by VAS score in S-TEP versus conventional laparoscopic arm seen by the end of 1 month.

Laparoscopic management of solid pseudo papillary neoplasm of pancreas in tertiary care center from south India.

BACKGROUND: Solid pseudo papillary neoplasm (SPN) of the pancreas which predominantly affects young women is a relatively indolent entity with favorable prognosis. Resection through minimal access approach helps to achieve better short term benefits. The aim of this study is to describe our experience in laparoscopic management of this disease. METHODS: A retrospective review of our prospectively maintained database revealed that 17 patients with SPN were managed with surgical resection between March 2009 and October 2016. The clinical data of these patients were then analyzed. RESULTS: Among the 17 cases of SPN, 14 were females and 3 were males. The mean age at presentation was 26.1 years (11-46 years). The most common presenting symptom was an abdominal pain (n = 10; 58.8%). A tumor was incidentally detected in 5 patients. The neoplasm was localized in the pancreatic head/neck in 6 patients and in the body/tail in 11. The median diameter of the tumors was 7.5 cm (2-13 cm). Five patients underwent pancreaticoduodenectomy, 10 had distal pancreatectomy, while median pancreatectomy or enucleation was performed in one each. All the patients were offered laparoscopic surgery; one distal pancreatectomy was converted to open in view of bleeding. The median length of stay was 7 days (5-28 days). The patients were followed up for a median period of 31 months (3-62 months). CONCLUSION: SPN is a rare neoplasm with low malignant potential and has an excellent prognosis. In our experience, laparoscopic surgical resection is safe and feasible, even for larger lesions.

Laparoscopic excision of rare case of recurrent presacral teratoma.

Tumours of the presacral space are rare to present. Most of them are benign masses, very rarely malignant. Surgery is the mainstay of treatment as it establishes the diagnosis and prevents the adverse consequences associated with malignant degeneration and secondary bacterial infection. Their surgical excision is often difficult because of their anatomic location. Very few cases have been reported so far concerning a laparoscopic management of presacral tumour. We hereby present a young girl with recurrent presacral teratoma. She underwent laparoscopic successful excision of tumour with uneventful post-operative recovery. Here, we are highlighting the importance of laparoscopic approach for this scenario in terms additional advantages of minimally invasive approach such as better visualisation of the deep structures in the narrow presacral space, precise dissection in a limited space between the tumour and neighbouring structures with avoiding injury to neurovascular structure.

A case report of modified laparoscopic keyhole plus repair for parastomal hernia following ileal conduit.

Parastomal hernia is one of the most common but challenging complication after stoma formation. Modified Sugarbaker technique is the recommended procedure for repair parastomal hernia, however, keyhole repair technique had also been used in certain instances. In cases of parastomal hernia following ileal conduit procedure, the Sugarbaker technique is been described, although with associated theoretical risk of conduit failure. We are reporting a case of post-radical cystectomy with ileal conduit presented with symptomatic large parastomal hernia. Laparoscopic modified keyhole plus repair has been done successfully in this patient with no recurrence in 2 years of follow-up. The purpose of our case report is to describe our novel modification of the laparoscopic keyhole technique which can be a feasible and acceptable alternative surgical method in these types of patients.

Laparoscopic management of 'Y-shaped' gallbladder duplication with review of literature.

Gallbladder duplication is a rare congenital malformation that occurs in about 1:4000 cases. Congenital anomalies of the gallbladder and anatomical variations of their position are associated with an increased risk of complications during laparoscopic cholecystectomy. We report a case of gallbladder duplication with symptomatic cholelithiasis, who presented with recurrent episodes of biliary colic and subsequently underwent laparoscopic cholecystectomy with intraoperative cholangiography. We also discussed in brief about the available literature support in relation to incidence of this disorder, imaging modalities used, intraoperative strategies and recommended measures for safe outcomes.

Laparoscopic total pancreatectomy for multiple endocrine neoplasia type 1 syndrome-associated multifocal, non-functioning pancreatic neuroendocrine tumor: A case report.

Pancreatic neuroendocrine tumors are rare, accounting for less than 3% of all pancreatic tumors. Although laparoscopic pancreas-preserving surgery for managing sporadic pancreatic neuroendocrine tumors has been described in the literature, laparoscopic total pancreatectomy has rarely been reported. We present a 30-year-old man who was incidentally diagnosed with multiple endocrine neoplasia type 1 syndrome with parathyroid hyperplasia and a non-functioning pancreatic neuroendocrine tumor. He underwent laparoscopic total pancreatectomy with splenectomy. This report highlights the technical details of laparoscopic total pancreatectomy, which appears to be a feasible and safe option in select cases.

Comparison of Effects of Sleeve Gastrectomy and Gastric Bypass on Lipid Profile Parameters in Indian Obese: a Case Matched Analysis.

BACKGROUND: Obesity is associated with increased mortality due to higher cardiovascular risk. A proportion of this risk is attributed to impaired lipid profile in the form of high levels of serum total cholesterol, triglycerides, and low levels of HDL cholesterol. Both sleeve gastrectomy (LSG) and gastric bypass (LGB) have been shown to have favourable effects on lipid profile with some variability in improvement. We aimed to study the difference in changes in lipid profile after LSG and LGB. METHODS: We performed a retrospective case-matched study comparing effects of LSG and LGB on lipid profile of patients who underwent bariatric surgery from September 2014 to September 2015. The matching was done based on criteria of age and body mass index (BMI). RESULTS: Out of a total of 92 selected patients, 69 patients underwent LSG and 23 patients underwent LGB. There was a significant improvement in serum triglycerides and HDL cholesterol with no significant reduction in serum total cholesterol in both LSG and LGB group. There was a significant reduction in cardiovascular risk calculated as total cholesterol: HDL cholesterol ratio following bariatric surgery (p = 0.002). CONCLUSION: Both LSG and LGB have similar effects on lipid profile cardiovascular risk attributed to it in Indian obese. Thus, sleeve gastrectomy may be considered as effective as a gastric bypass for dyslipidaemia improvement in Indian patients.

Laparoscopic management of symptomatic residual appendicular tip: A rare case report.

Appendectomy is one of the most common emergency surgical procedures. Stump appendicitis is well-recognised entity has been described in the literature. Still, with recent advance in imaging technique, it remains as a clinical challenge for diagnosis and effective treatment. We present a case of 13-year-old boy who underwent laparoscopic appendectomy 3 months back and presented to us with acute abdomen associated with vomiting and fever. Imaging revealed the presence of a tubular residual inflamed tip of the appendix of size 4 cm laying in paracaecal position with approximately 50cc purulent collection around it. Subsequently, the patient underwent successful laparoscopic completion appendectomy with uneventful postoperative recovery. Histopathological examination confirmed that resected structure as an inflammatory residual appendix. For our knowledge, after an extensive search of English literature, no study had described about laparoscopic completion appendectomy for residual tip appendicitis. We authors hereby would like to emphasise the importance of complete removal of appendix not only stump part but also tip, especially in certain locations such as paracaecal, retrocaecal and subhepatic. Laparoscopy can be an option for the management of these patients, in selected cases, and with available expertise.

Do Bariatric Surgery-Related Type 2 Diabetes Remission Predictors Add Clinical Value? A Study on Asian Indian Obese Diabetics.

BACKGROUND: Bariatric surgery has emerged to be the most effective treatment strategy for the treatment of obesity and type 2 diabetes mellitus (T2DM) achieving high remission rates. Many factors have been evaluated with a potential to predict the improvement of glycemic control following bariatric procedures. This study aims to study the various predictive factors for T2DM and the ABCD score in obese diabetic patients undergoing bariatric surgery in a South Indian population. METHODS: A total of 53 obese patients (BMI > 30 k/m2) with T2DM who underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) from March 2014 to March 2015 were selected for the study. The patients were followed up to study the effects of various predictors of T2DM remission at 1 year. RESULTS: Out of the 53 patients, 35 (66%) underwent LSG and 18 (34%) underwent LGB. Patients (81.1%) had T2DM remission. Mean HbA1c values decreased from 8.07 ± 1.98 to 6.0 ± 0.71. Only higher pre-operative body weight (p = 0.04) and lower HbA1c level (p = 0.04) were significantly associated with T2DM remission. Higher absolute weight loss (p = 0.03) after surgery was also significantly associated with T2DM remission. ABCD score was not significantly associated with T2DM remission although patients with ABCD score higher than 7 demonstrated 100% remission rate. CONCLUSION: Among all the factors, only higher pre-operative weight and better glycaemic control along with better post-operative weight loss were significantly associated with the remission of T2DM. Although not significantly associated with remission of T2DM, higher ABCD scores had higher likelihood of remission.

Laparoscopic radical cholecystectomy for suspected early gall bladder carcinoma: thinking beyond convention.

BACKGROUND: Gall bladder cancer (GBC) is the most common and aggressive malignancy of the biliary tract with extremely poor prognosis. Radical resection remains the only potential curative treatment for operable lesions. Although laparoscopic approach is now considered as standard of care for many gastrointestinal malignancies, surgical community is still reluctant to use this approach for GBC probably because of fear of tumor dissemination, inadequate lymphadenectomy and overall nihilistic approach. Aim of this study was to share our initial experience of laparoscopic radical cholecystectomy (LRC) for suspected early GBC. METHODS: From 2008 to 2013, 91 patients were evaluated for suspected GBC, of which, 14 patients had early disease and underwent LRC. RESULTS: Mean age of the cohort was 61.14 ± 4.20 years with male/female ratio of 1:1.33. Mean operating time was 212.9 ± 26.73 min with mean blood loss of 196.4 ± 63.44 ml. Mean hospital stay was 5.14 ± 0.86 days without any 30-day mortality. Bile leak occurred in two patients. Out of 14 patients, 12 had adenocarcinoma, one had xanthogranulomatous cholecystitis and another had adenomyomatosis of gall bladder as final pathology. Resected margins were free in all (>1 cm). Median number of lymph nodes resected was 8 (4-14). Pathological stage of disease was pT2N0 in eight, pT2N1 in three and pT3N0 in one patient. Median follow-up was 51 (14-70) months with 5-year survival 68.75 %. CONCLUSIONS: Laparoscopic radical cholecystectomy with lymphadenectomy can be a viable alternative for management of early GBC in terms of technical feasibility and oncological clearance along with offering the conventional advantages of minimal access approach.